Healthcare Provider Details

I. General information

NPI: 1205079795
Provider Name (Legal Business Name): EDWARD JUNG DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10349 BALBOA BLVD STE 200
GRANADA HILLS CA
91344-7379
US

IV. Provider business mailing address

10349 BALBOA BLVD STE 200
GRANADA HILLS CA
91344-7379
US

V. Phone/Fax

Practice location:
  • Phone: 818-363-3100
  • Fax: 818-363-5353
Mailing address:
  • Phone: 818-363-3100
  • Fax: 818-363-5353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number30563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: